AWMI with CHB

A 76 years old k/c/o Diabetes mellitus, hypertension since last one year came to JIPMER, Emergency department with history of acute onset retrosternal chest pain since last two days. Pain was dull aching in nature and  was associated with giddiness. There was no history of  perspiration, vomiting,breathlessness. In the emergency department pulse of the patient was 60 per minute, BP=100/60 mmhg, Chest was bilateral clear, there were no added sound. ECG done in the emergency department is shown below

ECG 1

ECG 1 with marking

ECG 2

ECG 2 with marking

Please do not jump to the diagnosis, first step is to describe the ECG

Description of the ECG-AV dissociation, Atrial rate around 100 per minute, ventricular rate around 60 per minute, LAD, qRBBB in lead V1, ST elevation in lead V1-V4, ST segment depression with T wave inversion in lead V5,V6, I, avL

Diagnosis of the ECG- 1)Anterior wall myocardial infarction
                                       2) Complete heart block

Patient was admitted and started on antiplatelet and anticoagulation with heparin. As the patient was out of window period so he was not thrombolysed. Vitals were stable so pacing was not done.Patient improved gradually.

ECG Day 5

Description of the ECG-Normal sinus rhythm at 90 per minute, Normal axis, QS with ST elevation in lead V1-V4, occasional VPC present, premature atrial contraction beat present, no evidence of CHB any where